Provider Demographics
NPI:1144418518
Name:JULGA, LORI MALIE (PTA PHYSICAL THERAPI)
Entity Type:Individual
Prefix:MRS
First Name:LORI
Middle Name:MALIE
Last Name:JULGA
Suffix:
Gender:F
Credentials:PTA PHYSICAL THERAPI
Other - Prefix:
Other - First Name:LORI
Other - Middle Name:MARIE
Other - Last Name:REITH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:18740 W BLUEMOUND ROAD
Mailing Address - Street 2:
Mailing Address - City:BROOKHELD
Mailing Address - State:WI
Mailing Address - Zip Code:53045
Mailing Address - Country:US
Mailing Address - Phone:262-782-0230
Mailing Address - Fax:
Practice Address - Street 1:18740 W BLUEMOUND ROAD
Practice Address - Street 2:
Practice Address - City:BROOKHELD
Practice Address - State:WI
Practice Address - Zip Code:53045
Practice Address - Country:US
Practice Address - Phone:262-782-0230
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-10-10
Last Update Date:2007-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI450019225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI40160100Medicaid